Role of echocardiography and phonocardiography in diagnosis of mitral paraprosthetic regurgitation with Starr-Edwards prostheses.

Twenty-three patients who were symptomatic after mitral valve replacement, and in whom mitral parapros- thetic regurgitation was a possible cause of deterioration, were investigated by cardiac catheterization, phonocardiography, and echocardiography. Severe paraprosthetic regurgitation was present in ii patients and slight regurgitation in 2 patients. Two patients had aortic regurgitation which was responsible for their symptoms and the remaining 9 patients had either poor left ventricular function, an obstructed mitral prosthesis, or an obstructed tricuspid prosthesis. The various groups could not be identified on clinical, radiological, or electro- cardiographic features, but severe paraprosthetic regurgitation was associated with a reduced A2-OC interval on phonocardiography and normal septal movement with a large stroke volume on echocardiography. In view of the difficulties in clinical diagnosis, the value ofphonocardiography and echocardiography has been empha- sized, particularly in ill patients in whom, on the basis of these investigations, cardiac catheterization may be avoided.